What makes a wound chronic
A chronic wound is one that has stalled, has not made steady progress after several weeks, or has closed and reopened. Chronic wound care in St. Louis is built around that problem: regular visits, careful tracking and a plan that changes when the wound does not.
The most common chronic wounds are venous leg ulcers, diabetic foot ulcers, pressure injuries and ulcers caused by poor arterial blood flow. Each has a different cause, so each needs a different plan. Our guide to how wounds heal explains the normal stages and where a wound can get stuck.
Who chronic wound care helps
- People whose wound has lingered through several rounds of treatment
- People whose wound closed and came back in the same spot
- Older adults with diabetes, leg swelling or circulation problems
- People who spend most of the day in a bed, recliner or wheelchair
- Families who are doing dressing changes and are not sure they are working
What the treating clinician may do at each visit
Chronic wound care depends on comparison over time. At each visit, the treating clinician may measure the wound, describe the tissue and drainage, check the surrounding skin and compare the findings with the last visit.
The clinician also looks at what is keeping the wound open. That may mean checking circulation, swelling, pressure, footwear, signs of infection and how dressing changes are going at home. They may then adjust dressings, order compression or pressure relief, remove unhealthy tissue or order tests.
When progress stalls
A wound that stops getting smaller is a signal to step back. The clinician may revisit the diagnosis, look again for infection or poor blood flow, and ask whether the plan is practical for you to follow day to day.
The clinician may also recommend a vascular, podiatry or surgical specialist. Gateway helps arrange those appointments, and you can ask us about a second opinion wound review.
How Gateway arranges chronic wound care at home and in facilities
Chronic wounds need follow-up over a long stretch, and that is hard to keep up when every visit means a car ride. Gateway arranges visits where you live, whether that is a private home, a skilled nursing facility, assisted living, memory care or a rehabilitation center.
Around each visit, we handle:
- Scheduling visits and confirming availability for your location and care setting
- Collecting records, including past wound treatment and recent hospital stays
- Following up on dressing and supply orders
- Passing the clinician’s orders to home health or facility nurses
In a facility, we work with the nursing team so that orders, visit days and wound records line up from week to week.
Connecting wound care with primary care
A chronic wound is usually tied to a chronic condition. Blood sugar, heart failure, kidney disease, circulation and nutrition all affect how skin repairs itself, and your primary care clinician manages those.
Gateway helps keep the wound care team and primary care in contact, so a change in one plan is known to the other. If you need a primary care clinician who can see you at home, ask us about in-home primary care or about diabetes care.
Keeping a healed wound from coming back
Closing a chronic wound is not the end of the work. Skin over a healed ulcer stays weaker than the skin around it, and the original cause is usually still there.
The treating clinician may recommend long-term steps such as compression garments, protective footwear, pressure relief or daily skin checks. Before visits end, ask what your plan is and who to call if the area opens again.
What to report and when to call 911
Tell the treating clinician about spreading redness, rising pain, more drainage, a new odor, fever or chills, or a wound that is getting larger or darker. Our guide to the signs of wound infection describes what to watch for.
Gateway is not an emergency service. Call 911 for heavy bleeding, chest pain, trouble breathing, sudden confusion or fainting.
How to start
Call 314-325-0126, or request care and we will call you back. You do not need a referral. The web form asks only for a name and phone number, so keep health details for the call.
When we talk, it helps to know how long the wound has been open, what has been tried and which clinicians are involved. Facilities and practices can refer a patient or fax 314-786-7966.
Common questions
How long will it take my chronic wound to heal?
No one can give you an honest date. Healing depends on the cause of the wound, blood flow, your overall health and how well the plan fits your daily life. What the treating clinician can do is measure the wound at each visit and tell you whether it is moving in the right direction.
My wound healed and then opened again. Did I do something wrong?
Usually not. Venous ulcers, diabetic foot ulcers and pressure injuries often return because the cause, such as vein problems, nerve damage or pressure, is still present after the skin closes. Tell the treating clinician when and how it reopened, so they can adjust the prevention plan.
I have already been to a wound clinic. Is it worth asking again?
It is reasonable to ask. A different clinician can review what has been tried and may see the wound in a new way. A visit at home also shows things a clinic visit cannot, such as your chair, bed, shoes and supplies. We cannot promise a different result.
Does a wound that will not heal mean it is infected?
Not always. A wound can be slow because of pressure, swelling, poor blood flow or other health conditions. Infection is one possible cause, and it can develop at any point. Report spreading redness, warmth, rising pain, pus or fever promptly. Only the treating clinician can decide whether a wound is infected and what to do about it.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.